Bill Text: NH HB508 | 2019 | Regular Session | Introduced


Bill Title: Relative to direct primary care.

Spectrum: Partisan Bill (Republican 9-0)

Status: (Introduced) 2019-03-15 - Executive Session: 03/20/2019 01:00 pm Legislative Office Building 302 (MAY FOLLOW WORK SESSION) [HB508 Detail]

Download: New_Hampshire-2019-HB508-Introduced.html

HB 508 - AS INTRODUCED

 

 

2019 SESSION

19-0197

01/03

 

HOUSE BILL 508

 

AN ACT relative to direct primary care.

 

SPONSORS: Rep. Marsh, Carr. 8; Rep. Guthrie, Rock. 13; Rep. Edwards, Rock. 4; Rep. Kotowski, Merr. 24; Rep. Yokela, Rock. 33; Rep. Stapleton, Sull. 5; Rep. Warden, Hills. 15; Sen. Reagan, Dist 17; Sen. Gray, Dist 6

 

COMMITTEE: Health, Human Services and Elderly Affairs

 

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ANALYSIS

 

This bill declares that primary care providers providing direct primary care pursuant to a primary care agreement are not subject to the insurance laws, provided that certain conditions are met.

 

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

19-0197

01/03

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Nineteen

 

AN ACT relative to direct primary care.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

1  New Section; Direct Primary Care.  Amend RSA 415 by inserting after section 27 the following new section:

415:28  Direct Primary Care.

I.  In this section:

(a)  "Direct primary care agreement" means a written agreement between a primary care provider and a patient, a patient's legal representative, or a patient's employer, which meets the requirements of paragraph II.

(b)  "Primary care provider" means a health care provider licensed under RSA 329, RSA 326-B, or RSA 328-D, or a primary care group practice, who provides primary care services to patients.

(c)  "Primary care services" means medical services in family practice, general practice, internal medicine, pediatrics, obstetrics, or gynecology including the screening, assessment, diagnosis, and treatment of a patient conducted within the competency and training of the primary care provider for the purpose of promoting health or detecting and managing disease or injury.

II.  Primary care services resulting from a primary care provider entering a direct primary care agreement is not insurance and the primary care provider shall not be subject to the requirements of this chapter when the following conditions are met:

(a)  The agreement is in writing and signed by the primary care provider, or agent, and the individual patient or his or her legal representative.

(b)  The agreement specifies the periodic fee required and any additional fees for services not covered by the periodic fee, and may allow the periodic fee and any additional fees to be paid by a third party.

(c)  The agreement describes the health care services that are covered by the periodic fee.

(d)  The agreement describes the duration of the agreement and any automatic renewal periods.

(e)  The agreement allows either party to terminate the agreement in writing, without penalty or payment of a termination fee, at any time or after notice as specified in the agreement which shall not exceed 90 days.

(f)  The agreement prominently states that the agreement is not health insurance and the primary care provider will not file any claims against the patient's health insurance policy or plan for reimbursement of any primary care services covered by the agreement.

(g)  The agreement prominently states that the agreement is not workers' compensation insurance and does not replace an employer's obligations under RSA 281-A.

(h)  The agreement does not conflict with an existing contract the primary care provider has signed with an insurance company covering the individual patient.

(i)  The primary care provider is not otherwise required to obtain a license as an insurer, third party administrator, or insurance agent or insurance broker.

III.  The direct primary care practice shall not decline to accept new direct primary care patients solely because of the patient's health status.  A direct primary care practice may decline to accept a patient for cause, including, but not limited to:

(a)  The practice has reached a maximum capacity;

(b)  The patient has previously contracted for services for which they have not paid; or

(c)  The patient’s medical condition is such that the provider is unable to provide the appropriate level and type of primary care services.

IV.  If the direct primary care practice provides the patient with notice and opportunity to obtain care from another physician, the direct primary care practice may discontinue care for a patient for cause, including, but not limited to:

(a)  The patient fails to pay the periodic fee.

(b)  The patient has performed an act of fraud.

(c)  The patient repeatedly fails to adhere to the recommended treatment plan.

(d)  The patient is abusive and presents an emotional or physical danger to the staff or other patients of the direct practice.

(e)  The primary care provider discontinues operation as a direct primary care practice.

2  New Subparagraph; Discount Medical Plan Organizations; Direct Primary Care Plan.  Amend RSA 415-I:3, III by inserting after subparagraph (c) the following new subparagraph:

(d)  A plan that provides direct primary care meeting the requirements of RSA 415:28.

3  Prohibition of Exclusive Arrangement With Managed Care Insurers.  Amend RSA 420-I:1, III to read as follows:

III.  "Managed care" means any arrangement for the provision of physician services which is characterized by some measure of risk-sharing through capitated or other shared-risk compensation formulae, and which are characterized by the establishment and maintenance of a provider network available to subscribers or participants, and which provides incentives for subscribers or participants to use that network for covered services, and which ordinarily limit coverage or the extent of such coverage to physician services provided by that network.  "Managed care" shall include any managed care products or services or similar products including but not limited to those governed by RSA 415, RSA 419, RSA 420, RSA 420-A, RSA 420-B, and RSA 420-C.  "Managed care" shall not include direct primary care services which meet the requirements of RSA 415:28.  

4  New Section; Direct Primary Care.  Amend RSA 420-J by inserting after section 2 the following new section:

420-J:2-a  Direct Primary Care.

I.  In this section:

(a)  "Direct primary care agreement" means a written agreement between a primary care provider and a patient, a patient's legal representative, or a patient's employer, which meets the requirements of RSA 415:28.

(b)  "Primary care provider" means a health care provider licensed under RSA 329, RSA 326-B, or RSA 328-D, or a primary care group practice, who provides primary care services to patients.

(c)  "Primary care services" means medical services in family practice, general practice, internal medicine, pediatrics, obstetrics, or gynecology including the screening, assessment, diagnosis, and treatment of a patient conducted within the competency and training of the primary care provider for the purpose of promoting health or detecting and managing disease or injury.

II.  Primary care services resulting from a primary care provider entering a primary care agreement is not insurance and the primary care provider shall not be subject to the requirements of this chapter when the following conditions are met:

(a)  The agreement is in writing and signed by the primary care provider, or agent, and the individual patient or his or her legal representative.

(b)  The agreement specifies the periodic fee required and any additional fees for services not covered by the periodic fee, and may allow the periodic fee and any additional fees to be paid by a third party.

(c)  The agreement describes the health care services that are covered by the periodic fee.

(d)  The agreement describes the duration of the agreement and any automatic renewal periods.

(e)  The agreement allows either party to terminate the agreement in writing, without penalty or payment of a termination fee, at any time or after notice as specified in the agreement which shall not exceed 90 days.

(f)  The agreement prominently states that the agreement is not health insurance and the primary care provider will not file any claims against the patient's health insurance policy or plan for reimbursement of any primary care services covered by the agreement.

(g)  The agreement prominently states that the agreement is not workers' compensation insurance and does not replace an employer's obligations under RSA 281-A.

(h)  The agreement does not conflict with an existing contract the primary care provider has signed with an insurance company covering the individual patient.

(i)  The primary care provider is not otherwise required to obtain a license as an insurer, third party administrator, or insurance agent or insurance broker.

III.  The direct primary care practice shall not decline to accept new direct primary care patients solely because of the patient's health status.  A direct primary care practice may decline to accept a patient for cause, including, but not limited to:

(a)  The practice has reached a maximum capacity;

(b)  The patient has previously contracted for services for which they have not paid; or

(c)  The patient’s medical condition is such that the provider is unable to provide the appropriate level and type of primary care services.

IV.  If the direct primary care practice provides the patient with notice and opportunity to obtain care from another physician, the direct primary care practice may discontinue care for a patient for cause, including but not limited to:

(a)  The patient fails to pay the periodic fee.

(b)  The patient has performed an act of fraud.

(c)  The patient repeatedly fails to adhere to the recommended treatment plan.

(d)  The patient is abusive and presents an emotional or physical danger to the staff or other patients of the direct practice.

(e)  The primary care provider discontinues operation as a direct primary care practice.

V.  A primary care provider who has signed a contract with a health carrier which remains in force to receive capitated payments for the care of a patient shall not enter into a direct primary care agreement for the care of the same patient, unless the contract with the health carrier specifically allows this practice and the health carrier is provided a copy of the direct primary care agreement within a time frame specified by the contract with the health carrier.

VI.  A direct primary care agreement may authorize a primary care provider to serve as a patient's authorized representative and as a claimant's representative as defined in RSA 420-J:3 and participate in grievance procedures per RSA 420-J:5 and request external review per RSA 420-J:5-a, 420-J:5-b, and 420-J:5-c.

5  Effective Date.  This act shall take effect 60 days after its passage.

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